ADHD Weekly 2017-05-25

For many adults, retirement age can bring a new diagnosis. One of the fastest growing segments of those diagnosed with ADHD is senior adults. For many people it is an answer to the struggles they have dealt with their entire lives.

Researchers estimate that between 2-4 percent of adults older than 60 are affected by ADHD. The National Comorbidity Survey Replication (NCS-R) estimates that 4.4 percent of adults in the United States are affected by ADHD.

Senior adults, who may have adult children or grandchildren diagnosed with ADHD, are beginning to ask their doctors for an evaluation for ADHD. Others see medical professionals who are interested in looking beyond the idea that their patients’ struggles are related to age. The result is a growing number of senior adults seeking information about ADHD and treatment to manage their symptoms.

ADHD in the third part of life

“As we age we will notice some forgetfulness, difficulty in recalling information quickly, losing a train of thought, and getting distracted,” writes David W. Goodman, MD, a member of the CHADD Board of Directors, in ADHD in Adults Over Age Fifty for CHADD’s Attention magazine. 

ADHD symptoms typically begin in childhood; in evaluating for adult ADHD, a specialist is looking for symptoms to be present by the teen or, at the latest, the young adult years. But many senior adults found careers and life partners that created structure and routines that helped reduce the impact of symptoms during their lives, although the challenges of inattention and other symptoms frequently remained. When it’s time for retirement or following the loss of a spouse, the person finds himself afloat without that structure. That’s when ADHD symptoms can become magnified.

Too often those symptoms are dismissed as being part of old age when they are not, says Dr. Goodman. 

“ADHD may not be a diagnostic consideration when older people complain of cognitive difficulties,” he notes. “A study looking at memory clinics in this country found that only one in five centers screen for ADHD. Therefore, it is possible that ADHD symptoms may be misdiagnosed as something else.”

There can be additional difficulties in receiving an evaluation when the senior adult suspects ADHD. Some doctors are reluctant to evaluate or treat ADHD for senior adults. They either believe that because the person has gone this long without an evaluation it’s unnecessary now, or they are concerned that the standard treatment of stimulant medication could be counter-indicative for the person’s health.

Treating senior ADHD successfully

As long as the senior adult is in good health, the standard treatments for adult ADHD have a positive impact on the patient, Dr. Goodman writes.

“Treatment options for older adults with ADHD are similar to [those for] younger people,” he says. “Medication and/or behavioral [therapy] and organizational techniques are the initial recommendations depending on the severity of symptoms and the environmental demands of the person’s life.” Stimulant and non-stimulant medications can be prescribed, he writes, as long as they don’t interact with any medications the person is taking for other health conditions. 

“The approved maximum age for the use of these medications varies from 55 to 65,” Dr. Goodman says. “These ages are determined by the drug trial research that capped the inclusion of subjects at a certain age. This is not to suggest that these medications are not effective or safe in people with ADHD older than 65.” 

For more information, visit Treatment for Adults.

Dr. Goodman writes that there are three categories of medical issues to be reviewed:

• ADHD medication side effects exacerbated by age.
• ADHD medications interaction with existing medical illnesses.
• ADHD medication interaction with other prescribed medication and/or over-the-counter medications.

As for anyone with ADHD, an adult must work closely with his medical professional to personalize treatment so that it is most effective for him. Many adults will have co-occurring conditions, such as depression or anxiety, which also need to be addressed. Some adults will benefit from talk therapy or coaching, depending on their needs.

“Beyond medication for ADHD, psychotherapies are an important component of treatment,” Dr. Goodman says. “Since the primary impairing deficits for older adults are attentional and organizational, the immediate focus of therapy is behavioral skills for organization, time management, task prioritization, task shifting, and task-time allocation. Although there are some basic principles for organization, one-on-one therapy helps to individualize the skills to specific areas of impairment.”

A fresh start 

If you think you may have ADHD, or you have a parent in or nearing retirement age who may have ADHD, an evaluation and a treatment plan can help. Discuss your concerns with your doctor and ask for a referral to a specialist who works with senior adults.

During the evaluation, you may bring documentation from your job (human resources, employee assistance program, or management); you may also choose to include a friend or family member who can talk with the evaluating professional. This can help the professional to better understand the challenges with which you are coping.

If you are looking for a specialist, some resources include:

• CHADD Resource Directory
• Professionals Who Diagnosis and Treat ADHD
• Psychology Today Professionals Listing

For more information on senior ADHD and how it is treated, continue reading ADHD in Adults Over Age Fifty.

Are you dealing with ADHD symptoms in the retirement years? What would you suggest in helping others to address ADHD symptoms in their lives?

Senior adults diagnosed with ADHD for the first time in their retirement years have unique challenges. Understanding the problem and learning about treatments are the first steps to a new beginning for many people. Keep reading for more information on improving the “golden years.”